Aims: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).Methods: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Sco re, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H 2 O. A nomogram was developed based on the multivariable logistic regression model. Results: Overall 448 patients with a mean age of 66 ± 11 years were enrolled.In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) andQmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. Conclusions: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS. K E Y W O R D S bladder wall thickness, detrusor underactivity, lower urinary tract symptoms, pressure flow studies 1116 | DE NUNZIO ET AL. Residual urine 40 (0/80); 64.5 ± 96.4 Urodynamic Qmax, mL/s 8 (7/12); 9.2 ± 5.3 PdetQmax, cm H 2 O 50 (36/71); 57 ± 28 Shaffer Class 2 (1/3); 2.3 ± 1.5 Bladder contractility index 105 (83/130); 108 ± 33 Bladder outlet obstruction index 32 (13/56); 36 ± 32 Note: Data are presented as median (IQR); mean ± SD. Abbreviations: BWT, bladder wall thickness; I-PSS, International Prostate Symptom Score; IQR, interquartile range; PdetQmax, pressure at maximum flow rate; Qmax, maximum flow rate. DE NUNZIO ET AL. | 1117 5 | CONCLUSION Our nomogram including BWT and Qmax shows good discrimination, calibration, and clinical benefit for the diagnosis of DUA. After external validation, the implementation of our nomogram could improve the management/counseling of patients with LUTS/BPH.

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Aims The aim of our study was to evaluate the relationship between smoking, metabolic syndrome (MetS) and persistence of nocturia in patients with moderate/severe nocturia (nocturia episodes ≥2), lower urinary tract symptoms (LUTSs), and benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). Methods From 2015 onward, a consecutive series of patients with moderate/severe nocturia (nocturia episodes ≥2), LUTS, and BPE undergoing TURP were prospectively enrolled. Medical history, physical examination, and smoking status were recorded. MetS was defined according to Adult Treatment Panel III. Moderate/severe persistent nocturia after TURP was defined as nocturia episodes ≥2. Binary logistic regression analysis was used to evaluate the risk of persisting nocturia. Results One hundred two patients were enrolled with a median age of 70 years (interquartile range: 65/73). After TURP, moderate/severe nocturia was reported in 43 of 102 (42%) of the patients. Overall 40 of 102 (39%) patients presented a MetS, and out of them, 23 of 40 (58%) presented a moderate/severe persistent nocturia after TURP ( P = .001). Overall 62 of 102 (61%) patients were smokers, and out of them, 32 of 62 (52%) presented moderate/severe persistent nocturia after TURP ( P = .034). On multivariate analysis, prostate volume, MetS, and smoking were independent risk factors for moderate/severe persistent nocturia after TURP. Conclusion In our single‐center study, MetS and smoking increased the risk of moderate/severe persistent nocturia after TURP in patients with LUTS‐BPE. Although these results should be confirmed, and the pathophysiology is yet to be completely understood, counseling smokers and MetS patients about the risk of postoperative persistent nocturia is warranted.